Authorization Management Specialist (Amber Specialty Pharmacy)
Amber Specialty PharmacyAbout the role
Additional Considerations (if any):
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At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions.
Monday-Friday (no weekends)
Hours: 8 a.m. - 5 p.m. CST
Wages: Hourly $19.00 to $20.00
Six paid holidays
Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.
Amber Specialty Pharmacy
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Job Title: Authorization Management Specialist
Department: Operations
FLSA: Non-Exempt
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General Function
Responsible for preparing appeal summaries and prior authorizations, correspondence with prescriber's offices, and documenting information in the electronic medical record. Gathers pertinent patient history and information, evaluates information, prepares responses, and completes appeals and prior authorizations accurately and timely.
Reporting Relations
Reports to: Authorization Management Specialist, Lead
Direct Reports: None
Primary Duties and Responsibilities:
Initiates and completes prior authorizations and appeals for specialty pharmacy
Work directly with providers, health plans, PBMs, and other specialty pharmacies to relay vital information and provide a high level of service
Communicates with providers, health plans, PBMs, and patients to obtain the status of pending prior authorizations and appeals
Submits prior authorization and/or appeal requests via electronic, phone, or fax on behalf of physicians/providers as allowed
Assures that all prior authorization and appeal documents, databases, and records are maintained accurately and timely
Evaluate and process claims rejected for prior authorization following company policies and procedures
Advocates on the patient's behalf to identify and assess coverage issues
Assists licensed professionals in reviewing patient chart notes and payer requirements to determine why cases are an appropriate course of action
Assures timeliness and appropriateness of all PA requests and provider appeals according to state, federal, and company guidelines
Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual
Professional Competencies:
Proficient with MS Excel, Word, and Outlook
Understanding of insurance verification and online prescription adjudication
Strong oral, written, and interpersonal skills
Self-initiative
Demonstrated ability to meet tight deadlines
Ability to work with all levels of internal management and staff, as well as outside clients and vendors
Working knowledge of Medicare, Medicaid, Commercial Insurance, and renal programs related to pharmacy, billing, grants, co-pay cards, prior authorizations, and rejectio
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